Tag Archives: pregnancy

An Insurance Penalty From Postpartum Depression

In January, a government-appointed panel recommended that all pregnant women and new mothers be screened for depression. Public health advocates rejoiced, as did untold numbers of women who had not known that maternal mental illness even existed before it hit them like a freight train.

But the panel did not mention one possible consequence of a diagnosis: Life and disability insurance providers have sometimes penalized women with these mental illnesses by charging them more money, excluding mental illness from coverage or declining to cover them at all. And it’s perfectly legal.

Many insurance companies lump these women with the larger pool of people in whom more general depression has been diagnosed. That can leave those with mild to moderate cases that came and went facing higher rates, even if they may not be at higher risk of suicide or being unable to work. But insurers base decisions on actuarial data, and the historical underdiagnosis of mild to moderate postpartum depression means there is not much long-term data for insurance companies to use.

Not every woman will pay higher rates, and the fear of doing so is not a good reason to avoid screening or necessary treatment. Women who are aware of the potential insurance problems can theoretically circumvent them in the short term. Any woman who has never given birth but hopes to get pregnant soon should buy as much life and disability insurance as she thinks she will need before she conceives.

To read the full story, click here.

Jeffrey R. Ungvary President

Jeffrey R. Ungvary

Panel Calls for Depression Screenings During and After Pregnancy

Women should be screened for depression during pregnancy and after giving birth, an influential government-appointed health panel said Tuesday, the first time it has recommended screening for maternal mental illness.

The recommendation, expected to galvanize many more health providers to provide screening, comes in the wake of new evidence that maternal mental illness is more common than previously thought; that many cases of what has been called postpartum depression actually start during pregnancy; and that left untreated, these mood disorders can be detrimental to the well-being of children.

It also follows growing efforts by states, medical organizations and health advocates to help women having these symptoms — an estimated one in seven postpartum mothers, some experts say.

“There’s better evidence for identifying and treating women with depression” during and after pregnancy, said Dr. Michael Pignone, a professor of medicine at the University of North Carolina at Chapel Hill and an author of the recommendation, which was issued by the United States Preventive Services Task Force. As a result, he said, “we specifically called out the need for screening during this period.”

The recommendation was part of updated depression screening guidelines issued by the panel, an independent group of experts appointed by the Department of Health and Human Services. In 2009, the group said adults should be screened if clinicians had the staff to provide support and treatment; the new guidelines recommend adult screening even without such staff members, saying mental health support is now more widely available. The 2009 guidelines did not mention depression during or after pregnancy.

To read the full story, click here.

Jeffrey R. Ungvary President

Jeffrey R. Ungvary

A Push To Make Pregnancy A Qualifying Life Event

More than 50 House Democrats are asking the Obama administration to add pregnancy to the limited list of reasons women may enroll year-round in coverage on the Obamacare exchanges.

Once the second, extended enrollment period ends April 30, Americans may only sign up for marketplace coverage if they have experienced a major life event like a divorce or the birth of a child. As things stand now, pregnancy doesn’t qualify as a reason a woman could enroll in coverage outside the official signup season.

Advocates for the health law, led by the group Young Invincibles, have been pushing the administration on that front for the last month, asking it to issue a rule making pregnancy a “qualifying life event.” They’ve convinced House members to join their cause, too, led by Rep. Bonnie Watson Coleman, D-N.J.

“The Affordable Care Act has made historic progress towards ending discrimination against women in the health insurance market by requiring plans to cover maternity care…however, many women are still vulnerable,” says a letter sent Thursday to Health and Human Services Secretary Sylvia Mathews Burwell by Coleman and 54 House members.

“Special enrollment periods currently exist for qualifying life events like the birth of a child or the adoption of a child. We believe pregnancy should trigger a similar special enrollment period,” the letter says.

Nearly three dozen health advocacy groups, including the American Congress of Obstetricians and Gynecologists,also wrote to Burwell on Thursday asking for the change to be made. Young Invincibles says 50,000 people have signed a petition as well.

To read more, click here.

Jeffrey R. Ungvary President

Jeffrey R. Ungvary

Women and the Battle for Quality Facilities to Give Birth

As a husband and father of three (girls), this is of interest to me.

Where a woman delivers her baby can make a major difference to her own health — a quality gap that remains largely hidden from mothers-to-be.

A new study comparing hospitals nationwide finds that women who delivered at low-performing facilities suffered more than twice the rate of major complications for vaginal births. For cesarean section deliveries, the disparity was even greater: nearly a fivefold difference, according to the study in Monday’s issue of Health Affairs.

But try to figure out which hospital in your area provides better care and odds are you’ll be frustrated. There’s no comprehensive database that women and their families can rely on to find the best hospitals ahead of time.

That appears to be changing. Spurred in part by the new research, medical groups such as the American Congress of Obstetricians and Gynecologists are working on a consumer-friendly database that will tap clinical information from electronic medical records. That effort could take another three to five years.

Monday’s study comes amid a national effort to improve medical quality, and hopefully reduce costs, by using data to compare care providers. Those lagging usually try to improve. Research-based approaches have been used successfully in other industries.

The study did not identify hospitals.

Led by Dr. Laurent Glance, a professor of anesthesiology at the University of Rochester medical school in New York, researchers analyzed billing data for a national sample of more than 750,000 deliveries in 2010.

About 4 million women give birth every year in the U.S., and having a baby is the single most common reason for a hospital stay. While pregnancy-related deaths are rare, complications are about as common as for heart surgery.

The study did not look at outcomes for babies. It grouped hospitals into three quality categories — low, average, and high — according to their rates of complications for the mother.

To allow an apples-to-apples comparison, the researchers adjusted for differences in the health status of patients served by the hospitals.

At the low-quality hospitals, an average of nearly 23 percent of the women delivering vaginally experienced a major complication, compared with about 10 percent of the women at high-quality facilities. The rate of complications at average-quality hospitals was 15 percent.

To read more, click here.

Jeffrey R. Ungvary President

Jeffrey R. Ungvary